02x11 - Graveyard Shift

[bunniefuu]

Clear!

[alarm blaring]

Continue. Charging, 360.

Charge to 360.

Clear!

[alarm blaring]

Continue. Charging, 360.

Clear!

Clear.

[beeping]

[sustained beep]

Come on. Come on!

Asystole.

I'm gonna call it. Any objections?

Time of death: 18:20.

He was looking at me.

He didn't want to die.

Just sh**ting hoops. Some guys drove by and popped him.

I'm sorry about that, Dr. Choi.

Goodwin just paged.

She wants to discuss your request.

Hey. I'm taking off. You coming?

No. I just got to wait for Rita to get here.

You go ahead.

All right.

See you tomorrow.

Yeah. See you.

[yawns]

Aren't you taking off?

Nah. Pulling another shift.

Malpractice premiums are due.

Ah, maybe it'll be an easy night.

Don't jinx it.

I look at her as just another patient.

But clearly she isn't.

If there's a bad outcome, does this thing become an international incident?

We have consent from all parties.

The State Department's been apprised.

You know, there is a potential upside to this, as long as you pull it off, so, all right.

Let's keep it under wraps.

Everyone involved signs a non-disclosure.

Yes, ma'am.

[exhales]

Dr. Halstead, incoming times three.

One, two, and three are all open.

Desmond?

15-year-old male, extremely combative.

Trashed our ambo on the ride over.

I'll k*ll you! I'll k*ll you!

No way to get vitals.

Managed to stick him with 5 of Versed, but no effect.

Looks like PCP maybe.

Got two more in the ambo behind ours.

10 of Haldol IM.

The other two like this?

I think they all took the same thing.

All right.

They're here.

Wheeler, stay with them. Clarke with me.

Okay, watch his feet.

Got it.

"Easy night." She jinxed it.

Cesar?

15-year-old boy.

He seized on the ride over but responded well to 5 of Versed IM.

We intubated en route.

All right. ABCs. Check the tube placement, get a quick exam, Ativan drip, then send him for head CT.

Got it.

Watch the lines.

Courtney?

Gave her 5 of Versed in the ambo, but didn't stop the seizing.

Have her on oxygen, but couldn't give her much else.

All right, Maggie, CBC, CMP, and blood gas on all three.

Send blood and urine for a tox screen.

Copy that.

On my count.

One, two, three.

Let's get an IV in and an NPA.

Yes, doctor.

[indistinct chatter]

On it.

All right.

He's 90 over 60.

Heart rate heavy.

Okay, let's move him.

Okay, here we go.

She's protecting her airway.

Thank you.

Okay, we're in.

Sat of 97%.

All right. Let's take advantage of her postictal state and get her head scanned.

Hey, bring Ativan with you.

Mm-hmm.

Coming through. Watch your back.

Look alive, Dr. Halstead.

It's a broad presentation. Are we sure they're all on the same thing?

Till we get tox screens, who knows?

I hope you don't mind that I'm dating your boyfriend.

No. Course not.

Why would I mind?

Can we still be friends?

Sure. I'll be your maid of honor.

So, what do you think?

Well, I don't understand why that woman doesn't mind.

Her friend betrayed her.

Hmm.

You sure she doesn't mind?

She said she didn't.

So, after reading the material I gave you, you told me that you suspected...

That I'm on the autism spectrum, that I have Asperger's.

Right.

So, how'd you feel if I told you that I thought that your diagnosis could very well be correct?

Relieved, actually.

My whole life, I've never understood why people treated me the way they did.

I felt there had to be something wrong with me.

Not wrong.

I mean, it's just different wiring. That's all.

Is there anything we can do to change that wiring?

Well, our wiring is pretty much our wiring, but there's a whole bevy of strategies out there.

I mean, medications, social skills training to help you recognize body language.

There's also a new therapy called TMS, but I'd probably recommend you going the traditional routes first.

TMS?

Transcranial Magnetic Stimulation.

It's so far FDA approved only for depression, but there is anecdotal evidence that it can benefit people with spectrum disorders.

I only mention it because we have a machine here at the hospital.

Well, I will do some research.

I am needed in the OR. Yes.

Dr. Charles, this has all been very comforting.

Thank you.

Of course.

[speaks Polish]

Hey, Maggie?

Hey.

Rita just called. She came down with the flu.

[sighs]

We're gonna be short tonight.

I know what that means. Another shift.

Well, think how much money you'll be making.

Ms. Goodwin?

Yes?

The patient's arriving.

Okay. Bring her up through the loading dock and use the service elevator.

Sure.

Loading dock?

Uh...

I'll tell you later.

Okay.

[gasping] Crows!

Get them away! [coughs]

5 of Haldol, please.

[coughing] They're in the...

It's all right.

We're taking care of those.

They're in the house!

No, no, no. We're taking care of those.

We're taking care of those.

[coughs]

We're taking care of those right now.

[breathing heavily]

There you go.

There we go.

Okay.

You know two out of three patients in here end up developing delirium?

From the fever? She has pneumonia.

Well, it's a contributing factor, but it's also the ICU itself.

You know, bright lights, the endless beeping, constant prodding and poking.

I mean, the woman's exhausted. Hey, Hank?

Could we maybe turn the lights down in Ms. Novak's room?

Maybe quiet the monitors a little bit?

Also, I don't think you need to be going in and out of there every 20 minutes, okay?

The woman needs some rest.

Sure.

Thank you.

[both exchange greetings in Polish]

I spoke to my mom today, told her I was a psych resident.

Oh, just now you're telling her?

Yeah. I knew how she'd react. And I was right.

She laughed.

She said I was the last person she could ever imagine being a psychiatrist.

Wow. Real vote of confidence there.

Mm-hmm.

Do I get to meet your mom someday?

You seeing what I'm seeing?

Yeah.

We need a CT surgeon, now.

Page Dr. Latham?

He's in surgery. Get Dr. Rhodes.

He's not on call.

Tell him it's an emergency.

I'm puzzled by this chart, Dr. Wheeler.

Did you do a rectal exam?

I didn't think in this case it was necessary.

It's always necessary.

It's a part of the physical exam, and it's expected.

I've seen too many things missed because feckless residents don't do a complete physical.

What's the troll still doing here?

Doesn't he have a bridge somewhere to go home to?

How's your boy?

Still out.

All right. CTs were all negative.

No swelling, no bleeds.

Tox screens are also negative.

Rules out usual suspects: heroin, meth, cocaine.

Then what?

Some synthetic cannabinoid.

What's your patient's heart rate?

Slow. 50.

Bradycardia. Rules out MDMA.

Mm-hmm.

See a lot of that in the field.

You think we're looking at spice?

Spice?

It's fake weed.

And it could be mixed with a number of things...

Flakka, krokodil.

Right.

None of that would show up in a tox screen either.

Nope. Well, hope one of them comes to and tells us.

Meanwhile, stay with the standard OD protocol: benzos and fluids.

Got it.

Oh, yes. Very nice.

Charity event at the Art Institute.

Hi, Maggie.

Robyn.

You concur?

Atrial septal defect.

But you feel it's an emergency?

Well, the patient's already anesthetized.

For just a CT? Is she mentally compromised?

No.

Wait. This doesn't look right.

The ribcage. Pectus carinatum. Is she deformed?

Come meet her.

Okay.

I'm really sorry about this.

It's okay.

I'll wait in the doctors' lounge.

Come find you in a little bit.

Mm-hmm.

Oh, here he is. Dr. Rhodes.

Thank you for coming in.

This is Mr. Hsieh from the Chinese Embassy.

Dr. Rhodes.

Mr. Woodfield, the director of the Chicago Zoo.

Doctor.

And the chief veterinarian, Dr. Evans.

Uh... zoo?

Your patient...

Meet Su Lin.

So, this was your idea?

Dr. Choi volunteers at the zoo.

Normally we wouldn't bring an animal in here, but we couldn't diagnose without a CT.

Well, that's fine, but I'm not a veterinarian.

She needs a cardiothoracic surgeon.

You've done this procedure many times.

Oh, yeah, I have, on human beings.

Same plumbing, just bigger.

cr*ck her chest and plug the hole.

I can't... no, I can't just cr*ck her chest.

She'll lose too much blood, and what am I supposed to transfuse with?

Do we have panda in the blood bank?

So, how do we treat her?

[chuckles] Um...

I guess I would have to take her up to the cath lab and close the defect with a balloon.

Okay. Then do it.

Really? Are we sure that we're all comfortable spending our time and the hospital's resources to save an animal?

Dr. Rhodes, zoos rent pandas from the Chinese government for a million dollars a year.

Why? Because people love pandas.

So, if we save this one, it's a public relations coup for this hospital...

One which will lead to much-needed donations to save human lives.

And... and there's an issue beyond that.

I've learned that there are less than 2,000 pandas left in the world.

Connor, we should do whatever we can to keep her alive.

One parrot, and he's Dr. Doolittle.

[laughs softly]

Okay.

Let's get Su Lin up to the cath lab.

Thank you.

Hi. I'm Dr. Wheeler.

Do you know where you are?

Do you understand?

Can you tell me how you got here?

[grunts]

[clattering]

Help!

Grab him.

Aah! No!

Get away!

I got you. 5 Versed, 10 of Haldol IM.

Got it.

[grunts] I'll k*ll you!

Get the restraints back on this kid.

What's wrong with him?

Delirium can sometimes be a sign of kidney failure.

Happens with these dr*gs.

The kids' parents are on the way in.

There's nothing good to tell them.

Okay, I'll be right back.

She's doing much better.

Very good.

Well, been a long day. I'll see you tomorrow?

Mm-mm. I volunteered to be on call tonight.

Really?

Mm-hmm.

Wow. I applaud your work ethic.

But, um... but why?

This patient.

I'm afraid that once the nurses change shifts, our instructions won't get passed on.

I think that our excellent staff will probably follow through.

I mean, aren't you exhausted?

Mm-mm. It's not a problem.

Coffee beans?

Mm-mm. Robusto espresso beans.

If I eat five an hour, I can go all night.

Got it. You know, Dr. Reese, I know your mother might have some doubts about your future as a psychiatrist, but I for one do not.

I mean, not even a tiny bit.

I'm just saying you have nothing to prove to me.

Well, it's not that. I just want to make sure our patient gets the treatment that she needs.

Oh. Okay.

You know, I've been meaning to mention: I recommend to all of my residents as part of their training that they undergo some form of psychotherapy.

Is that something you'd ever consider?

Me? No.

Well, I mean, the idea being that it might benefit you professionally, you know, to see what it's like to be on the other side.

I mean, it certainly benefitted me.

I really can't see myself in psychotherapy, Dr. Charles.

Okay.

Well, just a thought.

See you in the morning.

Sorry, Robyn, but it looks like it's gonna be kind of a long night.

Tough case?

On the DL...

Yeah?

The patient is a panda bear.

A panda?

Mm-hmm.

Atrial septal defect.

Can you fix it?

Well, that's the idea.

You know there are less than 2,000 pandas left in the world?

Somebody mentioned that.

Connor, what you are doing... It is so great.

Yeah?

Yeah.

Very sexy.

Alpha CT surgeon with a soft spot for animals.

[both laugh]

I'll call you a cab.

No. What? Are you kidding me?

No. I am sticking around. I love pandas.

Okay.

Yeah.

I got to go change.

Okay.

[both laugh]

This is weird.

4 West needs me to come down and declare a patient dead.

[scoffs]

What?

Nobody likes that job, so they dump it on the on-call psych resident.

You.

[sighs]

Are you clear on Mrs. Novak?

Yes, I'm clear.

All right.

It's a formality.

We need a doc to call it and tell the family.

Haven't you ever done this before?

No.

I'll help you. Here.

First thing: introduce yourself to the son.

I'm Dr. Reese.

I understand you're the patient's son.

Okay.

[clears throat]

I, uh... I am here to check on your father.

I'm afraid he's passed.

Time of death: 22:05.

I am very sorry for your loss.

That was terrible. I was terrible.

Hey, what are you doing?

Mm, hospital called. Got to go back in.

What? Why?

'Cause they're swamped.

They need me.

Can't they get someone else?

No.

[sighs] But it's so late, and you already worked a full day.

Yeah. I'm used to it.

I don't mind.

Shouldn't you be taking it easy?

I mean, you know, the baby.

Really, Tate? We're gonna do this again?

How many times do I have to say it?

Pregnant women can work.

What about pregnant women with TB?

[sighs]

The dr*gs knocked it down, and you know that.

I'm so sick of you bringing up this work thing.

I worry about you. And the baby.

Well, stop. I'm good.

And the baby's good.

I'll see you in the morning.

Yeah.

I think you're a little posterior.

How's it look in flouro?

Give me a view at 120.

One sec.

Right there. That's it.

All right. We're almost there.

Hold on. Heart rate's spiking.

Damn. I can't continue if she's this tachycardic.

We got to slow her heart down.

You gonna cardiovert?

No. All this fur... We'd never get enough contact with the skin.

Marty, give her 6 milligrams of adenosine.

On its way.

Mean arterial pressure of 70...

60... 40.

No pulse. Heart's arrested.

She's gonna come back, right?

Humans do.

But this is the first time that I've given adenosine to a panda.

Got a pulse.

MAP back up to 50... 60.

Connor, no good. She's still in SVT and her pressure's down.

All right, we've got no choice.

We've got to try to cardiovert her.

Shave her.

[clippers buzz]

Sync. Clear.

Still SVT.

All right. Charge to 150.

Sync.

Sinus rhythm.

All right, we're stable enough.

Let's proceed.

Shouldn't you people be working?

They're treating a panda in the cath lab.

So much for non-disclosure.

How's it looking?

Dr. Rhodes just deployed the ASD closure device.

I always learn so much watching him.

Oh, hey there.

Oh, hey, Dad.

Hear there's a panda in there.

Yeah. ASD repair.

Hm. Of course.

Wow. Looking sharp.

Connor and I were at a charity event when he got the call.

Good thing you got your mom's looks is all I can say.

Have a good time.

Hey, Dad?

I'm gonna be here a while.

How about a coffee?

Oh.

Yeah. Yeah, I got some time.

We're still waiting on test results, but we suspect it's some type of OD.

Hey. Sorry to call you back in.

No. I'm fine.

Tate's not, though.

Oh.

Girl, my work is a problem for him.

I really thought we were past it, but he won't let it go.

Well, every couple's got stuff they got to deal with.

You're needed in 2.

No way I'm gonna stop working.

Mom, Dad?

I'm sorry.

Oh, Rudy.

BUN is 130. Creatinine is 6.

You look at his output?

Renal failure.

I'm afraid Rudy's going to need emergency dialysis.

Put a temporary dialysis catheter in his left subclavian.

Okay.

Um, I'm sorry, folks. We're gonna need you to wait outside.

Thank you, April.

Yes.

Are you in?

No.

Must have hit the lung. Pneumothorax.

Let's get a chest X-ray.

Oh, no.

[groans]

All right.

Let's see if this lung is down.

Yep, it is.

No, I'll... I'll do the line.

I... I don't know what happened.

Prep a chest tube.

Really, I thought I had it.

Hey, it happens. The lung will be fine.

You'll get it.

How's my son?

Um, Dr. Halstead will give you an update.

So, uh... So, how's this new apartment?

Mm, it's fine, except for my upstairs neighbor.

He practices clarinet two hours every night.

And it's always the same two songs:

"Summertime" and "Moon Dance."

Ha! Well, of course, you know your mother and I's first date was a Van Morrison concert.

Hard for me to imagine you two dating.

We had some very happy times, especially when you first came along.

You don't remember? Mackinac Island?

All that saltwater taffy?

No.

In frickin' paradise, man.

Walking on the beach.

When you were four, you...

You found this pebble that you were absolutely convinced looked like a bunny.

A bunny?

Yeah.

You and your bunnies, man.

Loved your bunnies.

Robyn, I'm so very sorry I was an awful father.

I know, Dad. I know that.

But to tell you the truth, I never really felt that way.

Okay, all right. I will admit that I was angry, yes.

But it's just because I wanted more of you.

I remember I used to read my "Nancy Drew" mysteries and imagine that I was your detective.

You know, following you around, helping you solve cases.

Like... like how did my patient develop a fixation with doorknobs and stuff?

Yeah, yeah. Something like that.

Actually, I'm surprised that you, my brilliant psychiatrist father, never figured it out.

Epidemiology is detective work.

So, you see, Dad, it's all about you.

I'm all about you.

[coins jingling]

You carry that around with you?

Always.

Uh, we need you to pronounce a patient.

Where's the doctor who ran the code?

No code. Patient had a DNR.

This is Dr. Latham's patient. Why didn't you call him?

The family's in there. He'd have to tell them.

So?

You know Dr. Latham.

He's a robot. Creeps people out.

He'll just make them feel worse.

[sighs] Great.

Second time tonight.

[sighs]

Dr. Latham.

Why is that resident in with my patient?

I'm afraid the patient has d*ed.

Dr. Reese is informing the family.

Why wasn't I called?

We didn't see the need to bother you.

It's no bother. I'm... it's my responsibility.

Guess we should've, Dr. Latham.

I don't think that's very funny.

A word, doctor?

Mm-hmm.

Can you explain what that was about?

They didn't call you because they don't think you're very good with emotionally distraught people.

Oh.

Thank you for your candor.

Mm-hmm.

Well, the boy stopped seizing, but he's got cerebral edema.

Rick. That's his name.

Hopefully mannitol will bring it down.

When Rick wakes... If he wakes...

We'll do cognitive tests, but I'll tell you: he's gonna have deficits.

Deficits?

Yeah. Like walking, talking, bladder and bowel control.

And the girl? Janna?

EEG shows she continues to have subclinical seizures.

We had to put her in a barbiturate coma.

Possible she doesn't wake up.

Never wakes up, renal failure, deficits, coma...

Wheeler?

They're just kids.

What's the matter with you?

Wheeler, are you drunk?

Their lives are over.

Hey! Are you drunk?

Ugh, ED docs.

You're through tonight.

Let's get him in the lounge.

Oh, God, wait!

Oh!

Beautiful.

Thank you.

Let's go.

Excuse me.

So, normal BP for a panda is 150/85.

She's down to 110/60, and her heart rate's twice what it should be.

Grab me the ECHO, will you?

Yeah.

Here you go.

Thanks.

She has an effusion around the heart.

Yeah. Low-pressure bleed.

Damn. I must have nicked the right atrial appendage during the occlusion.

All right, we've got to relieve the pressure.

And we shouldn't open her up.

No. Can't risk the blood loss.

Yeah.

Okay. I'll needle her, put in a drain, and hopefully the bleed will stop on its own.

Give me the PeriVac kit.

Yes, doctor.

Thanks.

All right. Keep your fingers crossed.

Dr. Charles.

I looked online at the therapies that you mentioned.

I decided to try TMS.

In some cases, patients experience profound changes immediately, after one treatment.

Whoa, whoa, whoa, whoa, whoa. Some cases. Most of those, a single treatment caused only temporary change.

Fifteen minutes, half an hour.

Even with multiple treatments, there's no guarantee of prolonged change.

TMS is not a magic b*llet.

Still, it's encouraging.

It's very encouraging. But there's also the possibility that in success, your experience of TMS could be somewhat overwhelming.

Are you ready for that?

I am tired of living in a world I don't understand.

Very well.

I will refer you to my colleague in the morning.

I want you there.

You know that I can't prescribe treatments for doctors that work in the same hospital.

You referred me. I don't see why you can't observe.

Well, when you put it that way, I don't see why I couldn't, either.

Good. Let's start tonight.

Tonight?

If you don't mind.

It's three o'clock in the morning.

I'm not gonna call Dr. Weyland at 3:00 a.m.

I'll pick up the cost.

That's not the point.

Dr. Latham, are you sure that you don't want to go home and sleep on this?

Just think about it a little bit?

Dr. Charles, please.

Hey.

Hey.

How's she doing?

About the same.

No worse.

So, you volunteer at the zoo, huh?

Yeah.

How come?

You'll laugh.

Just try me.

All right. [sighs]

A few hours ago, I lost a kid who was sh*t.

Another one.

So much of my work... Stabbings, sh**t...

It's dark, man.

Worst of human nature.

But animals...

Not to say they don't k*ll each other, but they don't do it out of malice.

They're innocent.

They're light.

How do you feel?

Awful.

All right.

I'm not letting you drive home.

Why don't you go lay down in the on-call room?

Oh, God. Right in front of the troll.

Am I finished?

No.

It's not up to him.

You are gonna have to go to therapy, sign a contract saying it won't happen again, and if it does, you will be fired.

My parents...

How am I gonna tell them?

Hey, Wheeler, it's not the end.

Okay? You can get past this.

How is he?

Oh, physically okay.

Just hungover.

[chuckles] So, what did Abrams mean by "ED docs"?

Sad fact: among the staff, highest rate of alcoholism, ED docs.

Battle fatigue.

The session lasts 24 minutes.

Every 20 seconds, you'll receive a pulse, which lasts about two seconds.

Ready?

Yeah.

[rapid clicking]

You okay? Is it tolerable?

Yes.

[rapid clicking]

[crunching]

[phone rings and vibrates]

[alarm beeping]

Oh, Mrs. Novak.

Hold compressions.

Still VF on the monitor.

Charge 200.

Clear.

[sustained beep]

[alarm blaring]

She's gone.

She's dead?

Your patient, right?

Yes.

Do you want to call it?

Did you follow my instructions?

Of course.

Then what happened?

Respiratory failure.

She had pneumonia, you know.

Are you gonna call it?

Time of death: 4:02.

[whispering] This wasn't supposed to happen.

It's nobody's fault.

[voice breaking] Wasn't supposed to happen.

So, how you feeling? Any change?

Uh, not that I can tell.

Yeah? No headache?

No.

I hope you don't mind that I'm dating your boyfriend.

No, of course not.

Why would I mind?

Can we still be friends?

Sure. I'll be your maid of honor.

So, um, anything striking you differently?

That woman does mind.

She says she doesn't, but she clearly does.

Yeah.

She's being sarcastic.

You... you didn't pick that up before.

No.

Looks like you could be an excellent candidate for this therapy.

It's like I've been blind.

Blood has stopped draining.

BP and heart rate have normalized.

We've dialed back on the sedation, see how she responds.

No, no, no. We're not sh**ting a panda in my hospital.

She's coming around.

All right!

Looks good.

Well, we don't need a bear roaming the hospital.

Marty, put her back under.

Right.

Congratulations, everyone.

[speaks Polish]

[speaks Polish]

Dr. Reese, how's our patient?

She d*ed.

They all d*ed.

All of them. Three in one night.

Oh, that's terrible. I'm so sorry.

It's too much, you know? It's all too much. [crying]

We need to get you a little sleep.

No.

No. I...

I'll do it.

Dr. Charles, I want to do it.

I need it.

Do what?

Therapy.

I can't handle anything.

I'm no good at anything.

I'm... I'm a fraud. I'm just gonna disappoint you.

Come here.

[crying]

It's okay.

That's not gonna happen. That's not true at all.

[sobbing]

It's okay.

[chatter in Polish]

Excuse me. Have a good day.

So, we're gonna have to round on Wheeler's patients.

I'll take half, you take the other?

Okay.

And good job last night.

Thanks.

Yeah.

You hung in there. You should consider emergency medicine.

I will.

Morning.

Morning.

How'd it go?

The usual.

Good.

I guess I'm gonna start those rounds.

Yeah.

[sighs] April.

It's not that easy.

I know how much your work means to you.

I'm sorry.

Tate, we keep having the same argument.

We won't. Not anymore.

I mean it.

Look. I am the way I am. If I don't make you happy...

You do, April. I don't want to change you.

Okay?

Let's go home.

You can scramble me some eggs.

And now I'd like to introduce you to Dr. Connor Rhodes, who performed the procedure. Dr. Rhodes.

Thank you very much. Good morning to everybody.

Su Lin was suffering from an atrial septal defect, which...

[gentle music]

♪ ♪

Hey!

[indistinct chatter]

[child laughing]

♪ ♪